Severe hyperglycemic hyperosmolar state complicated by diabetic ketoacidosis and rhabdomyolysis in an obese adolescent patient: a case report.

backgroundIn the pediatric population, glucose metabolism-associated disorders most commonly manifest as diabetic ketoacidosis (DKA). Hyperglycemic hyperosmolar state (HHS) is a rare yet potentially grave condition in children that may coexist with DKA. Early identification is paramount to the effective management of both conditions. Consequently, each documented case contributes meaningfully to expanding the understanding and vigilance of pediatricians regarding acute diabetic complications. CASE PRESENTATION: We describe an obese 13-year-old Chinese girl presenting with moderate DKA, characterized by exceedingly high blood glucose levels large urine ketones (4+), venous pH < 7.2, serum bicarbonate < 18 mmol/L, and concomitant rhabdomyolysis. Given the severe hyperosmolarity (peculiar to DKA) and extreme hyperglycemia, she was diagnosed with mixed DKA-HHS. The patient responded favorably to fluid resuscitation and insulin administration; therefore, she was discharged in good general condition without residual complications and was followed up with insulin therapy. We elaborated on her clinical course in detail, with a review of the relevant literature.

conclusionsRecent guidelines from the International Society for Pediatric and Adolescent Diabetes (ISPAD) provide updated recommendations for the diagnosis and therapeutic management of DKA and HHS in children and adolescents. Early recognition and prompt treatment are highly emphasized in the guidelines to prevent complications and improve outcomes. The detailed account of this case may offer clinically pertinent insights to inform the development of future consensus statements.